Case 2
A 63-year-old male with severe aortic stenosis underwent AVR using a 23 mm, second-generation Trifecta valve in March 2018 but, two years later, was urgently admitted with acute heart failure due to severe AR and visible bilateral pulmonary congestion on X-ray (Fig.2). Blood gas analysis revealed acidosis-induced multiple organ failure and extracorporeal membrane oxygenation resuscitation was necessary for cardiogenic shock and loss of consciousness. An urgent AVR (21-mm Inspiris Resilia aortic valve) was performed. Two leaflet detachments were observed at the bottom of the left coronary cusp and parastent of the non-coronary cusp (fig.3). The patient died on the third postoperative day due to multiple organ failure.